Provider First Line Business Practice Location Address:
215 EAST 7TH ST. UNIT #A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-623-9171
Provider Business Practice Location Address Fax Number:
213-623-1030
Provider Enumeration Date:
09/30/2006